A comparison of monocyte counts and ex vivo and in vitro monocyte cytokine production after major surgical trauma.
BACKGROUND
Impaired function of cluster of differentiation 14-positive (CD14+) monocytes (MOs) after major surgical trauma is believed to predispose to infectious complications. Postoperative decreases in human leukocyte antigen (HLA)-DR expression, tumor necrosis factor-alpha (TNF-alpha) production and interleukin (IL)-12 synthesis have been reported. There are no studies comparing absolute MO counts and MO cytokine synthesis in peripheral blood and stimulated cultures.


METHODS
The study group included 10 low-risk patients undergoing elective cardiac surgery with extracorporeal circulation. Preoperatively (d0) and on the first (d1) and third (d3) postoperative d, we analyzed leukocyte counts, CD14+ MO absolute counts, HLA-DR expression, and stimulated IL-12 and TNF-alpha synthesis using flow cytometry. In addition, IL-12 and TNF-alpha release in stimulated whole blood cultures was assayed.


RESULTS
Whereas the absolute numbers of leukocytes and CD14+ MOs were significantly elevated, HLA-DR expression was suppressed postoperatively. The proportion of TNF-alpha- and IL-12-producing MOs was reduced after surgery. This, however, led to a significant postoperative decrease only in the absolute numbers of peripheral blood IL-12+ MOs. IL-12 secretion was postoperatively reduced in whole blood cultures. The IL-12-synthesizing capacity of IL-12+ MOs was significantly reduced only on d1.


CONCLUSIONS
The immediate postoperative period is associated with an increase in the absolute MO numbers and an impairment of MO function, which is reflected in a reduced capacity to synthesize IL-12 and TNF-alpha and a decreased ability to express HLA-DR and present antigens. Whereas the cytokine-producing capacity returns to normal levels on d3, the suppression of HLA-DR expression persists.
Franke
Axel
A
Department of Trauma and Reconstructive Surgery, German Armed Forces Central Hospital, Koblenz, Germany.
Lante
Wolfgang
W
Kollig
Erwin
E
Markewitz
Andreas
A
D000368:Aged; D002315:Cardiopulmonary Bypass; D018929:Cell Culture Techniques; D016207:Cytokines / Q000096:biosynthesis*; D017558:Elective Surgical Procedures; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000032:analysis; D019918:Heart Valve Prosthesis Implantation; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D018664:Interleukin-12 / Q000096:biosynthesis; D007958:Leukocyte Count; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008070:Lipopolysaccharides / Q000494:pharmacology; D008297:Male; D009000:Monocytes / Q000166:cytology / Q000187:drug effects / Q000502:physiology*; D011184:Postoperative Period; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D016207:Cytokines; D006684:HLA-DR Antigens; D006454:Hemoglobins; D018950:Lipopolysaccharide Receptors; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D018664:Interleukin-12